One of the best things about becoming a nurse is the wide range of choices nurses have about exactly what they want to do. Nurses of every stripe are in short supply nationwide, but as the health care system itself undergoes major changes and the U.S. population continues to age, the nursing profession is seeing major shifts in what kind of nursing skills will be most in demand for today’s nursing school graduates.

Nurse practitioners

There will be a much higher demand for basic primary health care in the coming years as more people get health insurance as a result of the Affordable Care Act. There is already a shortage of primary care doctors, especially in smaller towns and rural areas. One way to address the need is with nurse practitioners. These are nurses who have master’s degrees and may have specialized in a certain kind of care, such as geriatrics or pediatrics. They care directly for patients and have the authority to write prescriptions, order tests, and take care of other aspects of primary care.

“When you go out into other areas, you see there’s just one doctor for the population, you can bridge that gap to where other people have access to you as a health care provider,” said Susan Smithwick, an advanced practice nurse at the University of Arkansas for Medical Sciences who specializes in geriatrics — caring for older adults.

Nurse practitioners can earn a significantly higher salary than registered nurses — even into six figures for nurse anesthetists — and have a greater scope of responsibility. There’s a growing demand for nurse practitioners, especially in underserved areas, and schools are seeing growing numbers of applicants to their advanced practice nursing degree programs, said Dr. Sue McClarry, chair of the nursing department at Arkansas State University, which offers the only nurse anesthetist degree program in the state.

“We’re seeing a lot of students coming into our family nurse practitioner program and our [nurse anesthetist] program,” she said. “There’s going to be a great need for all of these roles, particularly with the Affordable Care Act.”

Heather Alverson earned her master’s degree in nursing science from UAMS in 2011, specializing in adult acute care. APNs are “the next best thing” when a physician isn’t available, she said. “They have a lot of decision-making capacity and knowledge base and can care for the patient. … The demand is more than we have doctors for in a lot of areas. This kind of role will be used to take up that slack.”

Arkansas hasn’t made as much progress as some other states in making full use of nurse practitioners, said Dr. Melanie J. Ware, a women’s health advanced practice nurse at UAMS, but she thinks that as health care providers and patients are more exposed to what nurse practitioners can do and how they can provide quality direct patient care, that will change. It will have to, she said.

“I don’t see how we’re going to be able to serve all the people of Arkansas without using nurse practitioners,” she said. “There are just not enough physicians to go around.”

Nurse education

The chronic, nationwide shortage of nurses isn’t because too few people are interested in becoming nurses. Instead, it’s because there aren’t enough nurse educators to teach everyone who’d like to study nursing. The University of Arkansas’ Eleanor Mann School of Nursing recently doubled the number of pre-nursing students it accepts into the nursing program from 100 a year to 100 each semester, and started an online RN-to-BSN program to serve even more students.

“We’re going to have an increased demand for more nurse educators,” said Dr. Ann Schlumberger, chair of the Department of Nursing at the University of Arkansas at Little Rock. “So many that we have now are going to be retiring in the next five or six years, and it’s going to be critical to bring more qualified, master’s and doctorate-educated nurses in so we’ll have the educators we need.”

Dr. Pegge Bell, director of the Eleanor Mann School of Nursing at the University of Arkansas, said even having a nursing education program in her school hasn’t made it easier for her to find faculty.

“We have a huge need for nursing faculty,” she said. “I think many [nurses] just don’t think about being a teacher.”

With the average age of nurses now over 50, the nursing profession is facing not just a major loss of nurses as that age group begins to retire, but also a major loss of nursing leaders.

“They are in the positions where some of the new graduates want to be,” said Lepaine Sharp-McHenry, assistant director of the U of A’s school of nursing. “We will not be producing the number of nurses needed to fill their jobs, even they everybody’s doubling their enrollment.”

Geriatrics

Smithwick’s specialty, geriatrics, is going to be one of the most in-demand areas for all kinds of nurses in the coming years, she said.

“With everybody aging, we need to come to the realization that we’re going to have more people with functional capacity issues, more people on more medications, with memory problems, and what are going to do with these people?” she said.

“Nursing has a major role to play in the care of older adults, regardless of setting,” said Dr. Claudia Beverly, director of the John A. Hartford Center of Geriatric Nursing Excellence at UAMS. Many nurses, however, don’t receive any specific education in geriatric care. One of the Hartford Center’s goals is to prepare nursing faculty to teach geriatrics so the student nurses of the future will have that training.

“They will have a job forever working with older adults,” Dr. Beverly said. Estimates are that 60 percent to 80 percent of nurses will work in a hospital, and 70 percent to 80 percent of hospital patients are over the age of 65. “We have to have a workforce prepared to do that,” she said.

Geriatric nurses also will be needed to work in nursing homes and for home health care agencies. Karmel Ancel, director of Parkway Village, which includes assisted living and nursing home facilities, said it’s hard to find nurses with experience in geriatrics.

“It’s very rewarding, but it’s not what people think coming out of nursing school that they want to do,” she said. “We don’t have TV shows about nursing homes.”

In nursing homes, she said, RNs are typically in more supervisory roles, and it’s difficult to find a nurse with both supervisory experience and geriatric experience. “We do a lot of our own training,” she said.

Hospice/palliative care

These related disciplines are both going to be growing as the U.S. population ages and as other medical advances allow people of all ages to survive with conditions that in previous years would have been fatal. Hospice care focuses on providing comfort care and improving the quality of life specifically for patients with six months or less to live. Palliative care provides the same type of care, but not just for patients who are terminally ill.

There’s been a growing understanding and acceptance of what hospice care really offers, said Kristie Davis, the hospice team leader for Baptist Health Hospice, and doctors are more willing now to provide treatments that will improve a patient’s quality of life, at least temporarily, but that aren’t meant to change the course of the disease.

“When I first started, somebody getting a blood transfusion was unheard of,” she said. “They weren’t going to do it. Now, if it makes [the patient] feel better for two or three weeks, we’ll do it.”

Hospice nursing is a true calling, Davis said. Nurses do more than provide physical care — they care for their patients’ emotional and spiritual health, and often for the patients’ family members too.

“We still have some people who will say, ‘I don’t want to talk about death and dying all day,’” she said. “Neither do we. We want to help you talk about your life and how to live it.”